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Hepatitis C in the US – A Bigger Issue than HIV

12th September 2017

Joel Roth, 65, of San Rafael, Calif., is a long-suffering Hepatitis C patient who is taking Sovaldi, which costs $1,000 per pill, or $84,000 for a 12-week treatment course. Roth got financial assistance to pay his $11,600 share of the bill. (Bob Ecker/MCT via Getty Images)

Ray Cavanaugh

Ray Cavanaugh is a freelance writer from Boston, MA. His interests include history, health topics, and current events in faraway places.

For ten years now, hepatitis C has accounted for more annual US deaths than HIV/AIDS. Compared to the 1.1 million living in the US with HIV, more than 3 million Americans currently have hep C, and half of them don’t know it.

In 2013, hep C mortality exceeded that of the combined sum of deaths from 60 other infectious diseases, among them HIV, pneumococcal disease, and tuberculosis. Additionally, as death certificates tend to underreport hep C, the number is in all likelihood higher.

From 2003 to 2013, deaths from infectious conditions other than hep C decreased by 28 percent, from 24,745 to 17,915. But during that same ten-year span, deaths related to hep C rose 75 percent, from 11,051 to 19,368. And that number has continued to rise.

After years of declining incidences of new hep C infections, the trend has reversed with a disturbing trajectory. The CDC estimated that 34,000 new cases of hep C infection occurred in 2015, and that the number of new cases almost tripled within a five-year period. The factor fueling this startling rise is the opioid epidemic and the use of shared needles.

Intravenous drug use is now the leading cause of hep C in the US. Though unsanitary medical conditions (such as tainted blood transfusions) are the primary cause of hep C in developing nations, this factor has declined drastically in the U.S. since 1992, with the implementation of more preventative measures, such as the sterilization of medical equipment and enhanced screening of potential blood and organ donors. With current U.S. screening methods, fewer than one in two-million units of donated blood are contaminated with hep C.

About 70-90 percent of older injection drug users (including former users) have hep C. In the 1980s and 1990s, 80-90 percent of intravenous drug users were infected within just one year of initiation to injection drugs, relates Dr. Andrew Talal, a Professor of Medicine at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

Talal, who has worked with hep C for the past 20 years, points out that, “Harm-reduction techniques for HIV were effective in significantly decreasing the risk of transmission of HCV as well.”

Though the perils of sharing needles has become more widely understood in recent decades, sharing does occur, and about one-third of injection drug users between ages 18 and 30 have hep C. In addition to being younger, the persons who now most often contract hep C are “frequently Caucasian, and from suburban or rural areas,” Talal adds.

Aside from opioid use, other causes of hep C include mother-to-child transmission (about six percent of infants born to mothers with hep C contract the virus), hemodialysis, tattoos provided in an unprofessional setting (such as a jail), and hospital accidents (such as needle-stick injuries). Though it rarely occurs, transmission by sexual intercourse is possible.

About 15-25 percent of people who contract hep C manage to eliminate it from their system and avoid chronic infection. However, an estimated 75-85 percent of those infected with the hep C virus will suffer from chronic infection. That said, people can go decades without showing any symptoms, and many have no idea they are infected until confronted with severe liver problems.

“That is why education of potential risk factors, methods of transmission and testing for the infection are so important,” Talal emphasizes. “As we have learned more, we have revised the estimate of the number of individuals who develop cirrhosis upward. It is now thought that if individuals are followed for long enough, for example for 40 years, the vast majority, if not almost everybody, will develop cirrhosis.”

Hep C is the most common reason for a liver transplant, and the virus recurs in 80-90 percent of those who receive a new liver.

Though such recently appearing drugs as Harvoni and Solvadi have proven highly effective at curing the disease, they are extremely expensive, costing about one-thousand dollars per pill. “The ability to obtain these medications varies from state to state,” says Talal, who observes that in his state, New York, “most individuals can get hepatitis C treatment.”

Though there are vaccines for hep A and B, no vaccine for hep C exists as of yet. Talal is optimistic, however, about the development of direct acting antivirals, which directly target the hep C virus. “These drugs can cure 95% of individuals, have much shorter treatment duration than the drugs that were used previously, and a much more favorable side effect profile, and don't require any injection. Unfortunately, many of those who are infected with HCV are unaware that interferon [which frequently had serious side effects] is no longer required to be part of the mix. Therefore, it is tremendously important that we continue to educate those who might be infected about the new therapeutic developments in hepatitis C.”

Talal is quite confident that hep C mortality will eventually decrease “as long as we get a handle on the opioid epidemic.”

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